Fail-safe programming for implantable medical device

ABSTRACT

In general, the invention is directed to a system with a fail-safe mode for remote programming of medical devices, such as implantable medical devices (IMDs). During a remote programming session, an adverse event, such as a programming session failure, may prevent proper completion of a programming or result in improper programming due to data corruption or other factors. If a programming session is not completed correctly, the IMD is susceptible to improper operation, possibly exposing a patient to delivery of unnecessary or inappropriate therapies. A fail-safe mode reduces the likelihood of improper operation following a programming session failure. The fail-safe mode defines one or more fail-safe operations designed to preserve proper operation of the IMD. In some embodiments, the fail-safe operations include notifying a person concerning the failure of the programming session, modifying programming parameters within the implantable medical device, and delivering a therapy to a patient.

TECHNICAL FIELD

The invention relates to implantable medical devices, and moreparticularly, to techniques for remote programming of implantablemedical devices.

BACKGROUND

Implantable medical device (IMD), such as implantable pacemakers,cardioverter/defibrillators, neurostimulators, implantable drug pumps,or the like, may be programmed and interrogated remotely via atelecommunication link. In particular, a remote programmer initiates aremote programming session to set parameters within the IMD and therebymodify therapy or monitoring for a patient. The programming session mayinvolve a local programmer/monitor, located proximate to the patient,that acts as an intermediary between the remote programmer and the IMD.

Remote programming allows a programmer to program an IMD from asignificant distance. A doctor may monitor the programming from anylocation that is able to access the same network to which the IMD isconnected, e.g., the Internet. In this manner, remote programming shouldmake patient visits to the clinic less frequent. Remote programming ofimplantable medical devices is likely to become more prevalent astechnology to enable safe remote implementation emerges.

SUMMARY

In general, the invention is directed to a system with a fail-safe modefor remote programming of medical devices, such as implantable medicaldevices (IMDs). During a remote programming session, an adverse event,such as a programming session failure, may prevent proper completion ofa programming or result in improper programming due to data corruptionor other factors. If a programming session is not completed correctly,the IMD is susceptible to improper operation, possibly exposing apatient to delivery of unnecessary or inappropriate therapies.

In accordance with the invention, a fail-safe mode reduces thelikelihood of improper operation following a programming sessionfailure. The fail-safe mode defines one or more fail-safe operationsdesigned to preserve proper operation of the IMD. In some embodiments,the fail-safe operations include notifying a person concerning thefailure of the programming session, modifying programming parameterswithin the implantable medical device, and delivering a therapy to apatient. As one example, the fail-safe mode may cause the IMD to revertto a default set of programming parameters in the event the programmingsession fails.

In one embodiment, the invention is directed to a method comprisinginitiating a remote programming session within an implantable medicaldevice, and invoking a fail-safe operation in the event the programmingsession fails.

In another embodiment, the invention is directed to a method comprisinginitiating a remote programming session within an implantable medicaldevice, and reverting to default programming parameters within theimplantable medical device if the remote programming session results ininappropriate operation of the implantable medical device.

In another embodiment, the invention is directed to an implantablemedical device comprising a communication interface for initiation of aremote programming session, and a processor that invokes a fail-safeoperation in the event the programming session fails.

In another embodiment, the invention is directed to a local programmerof an implantable medical device system comprising a communicationinterface for initiation of a remote programming session, and aprocessor that invokes a fail-safe operation in the event theprogramming session fails.

In another embodiment, the invention is directed to a remote programmerfor an implantable medical device, the programmer comprising acommunication interface for initiation of a remote programming sessionwith the implantable medical device, and a processor that invokes afail-safe operation in the event the programming session fails.

In another embodiment, the invention is directed to a system comprisingan implantable medical device, a local programmer that programs theimplantable medical device, a remote programmer that communicates withthe local programmer to initiate a remote programming session with theimplantable medical device, and a processor that invokes a fail-safeoperation in the event the programming session fails.

In other embodiments, the invention is directed to computer-readablemedia comprising instructions to cause a processor to implement methodsas described herein

The details of one or more embodiments of the invention are set forth inthe accompanying drawings and the description below. Other features, andaspects of the invention will be apparent from the description anddrawings, and from the claims.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 is a block diagram illustrating an exemplary implantable medicaldevice system that provides a fail-safe mode for remote programming.

FIG. 2 is a block diagram illustrating the system of FIG. 1 in greaterdetail.

FIG. 3 is a conceptual diagram illustrating an exemplary implantablemedical device (IMD) that provides fail-safe operations if an adverseevent occurs.

FIG. 4 is a conceptual diagram illustrating an exemplary localprogrammer/monitor that provides fail-safe operations if an adverseevent occurs.

FIG. 5 is a flow diagram illustrating remote programming of animplantable medical device (IMD) with exemplary fail-safe functionality.

FIG. 6 is a flow diagram illustrating remote programming of animplantable medical device (IMD) with exemplary fail-safe functionality.

DETAILED DESCRIPTION

The invention pertains to remote programming of an implantable medicaldevice (IMD). During a remote programming session, an adverse event,such as a communication failure, may prevent the proper completion ofprogramming or result in improper programming due to data corruption orother factors. To combat adverse events, the invention provides afail-safe mode, which may include notifying a person concerning thefailure of the programming session, modifying programming parameterswithin the implantable medical device, or delivering a therapy to apatient.

FIG. 1 is a block diagram illustrating an exemplary implantable medicaldevice system 10 that provides a fail-safe mode in the event an adverseevent occurs in the course of a remote programming session. As shown inFIG. 1, system 10 includes an implantable medical device (IMD) 12, alocal programmer/monitor 14, and a remote programmer 18. Remoteprogrammer 18 communicates with local programmer/monitor 14 via anetwork 16, which may include the Internet, LANs, WANs, wirelessnetworks, cellular networks, satellite networks, VPNs, and the like.

Local programmer/monitor 14 communicates with IMD 12 via short-range orlonger-range wireless telemetry. For example, local programmer/monitor14 may include a programming/interrogation wand for short-rangetelemetry with IMD 12, or a radio frequency antenna for longer rangetelemetry with the IMD. IMD 12 may be an implantable pacemaker, acardioverter/defibrillator, a neurostimulator, an implantable drug pump,an implantable monitor, or the like.

Local programmer/monitor 14 sets operating parameters within IMD 12 tocontrol therapy for a patient and monitor patient response to thetherapy. Remote programmer 18 initiates a remote programming ormonitoring session with IMD 12 via local programmer/monitor 14 vianetwork 16, and the local programmer/monitor then programs andinterrogates the IMD via local telemetry.

Remote programmer 18 relies on an array of intermediate networkingequipment along a telecommunication link, including network 16, tocommunicate with local programmer/monitor 14 and IMD 12. Theintermediate networking equipment, such as routers, servers, hubs, andthe like, as well as software, such as web browsers, drivers, and othercommunication and rendering modules, may create potential faults,outages and other adverse events within the telecommunication link.

In general, the conglomeration of equipment and software along thetelecommunication link creates an unpredictable, hazardous environmentthat presents reliability issues in the remote programming context.Transmission failures and data corruption are two possible effects of ahazardous environment. However, the sensitive nature of IMDs requiresstability of a controlled operating environment to promote viability ofremote programming.

Remote programming is further complicated by telemetry between localprogrammer/monitor 14 and IMD 12. As a result, a remote programmingsession may encounter an adverse event due to not only a failure in thetelecommunication link between remote programmer 18 and localprogrammer/monitor 14, but also a failure in the telemetry link betweenlocal programmer/monitor 14 and IMD 12, e.g., due to interference orout-of-range conditions. In either case, an adverse event may result ina programming session failure, inappropriate device behavior, orinappropriate patient response to improper parameters.

As discussed above, a programming session failure includes a disruptionin telemetry between IMD 12 and local programmer/monitor 14 locatedproximate the implantable medical device, a disruption in atelecommunication link between the local programmer/monitor 14 andremote programmer 18, a loss of connection between clinicianinstrumentation and remote programmer 18, or the like, and results inincomplete or improper programming. For example, a connection may belost between two devices if a power interruption occurs. In addition, aconnection may be lost if a device is out of range, or if the devicesuffers interference.

Inappropriate device behavior includes programming of inappropriateparameters due to inadvertent programming by the clinician or othermedical personnel, incomplete programming, power interruptions, orcorruption of data or instructions. Further, inappropriate devicebehavior includes improper operation by IMD 12, such as the occurrenceof an asystole by IMD 12, inappropriate IMD sensitivity settings,inappropriate AV delay settings, inappropriate refractory periodsettings, inappropriate pacing and defibrillation output settings andthe like.

Inappropriate patient response, caused by inappropriate operation of IMD12, include low pacing outputs, low pacing rate, loss of capture, lossof sensing or monitoring, loss of defibrillation efficacy, arrhythmia,and the like, in response to therapy delivery by IMD 12 based on theprogrammed parameters.

Fail-safe operations prevent harmful consequences from inappropriateprogramming caused by an adverse event during remote programming, asdescribed above. Fail-safe operations include notifying a personconcerning the failure of the programming session, modifying ormaintaining programming parameters within the implantable medicaldevice, delivering a therapy to a patient, or a combination of suchoperations. Notification of programming session failure permits thepatient to seek medical attention immediately, and may take the form ofan audible, visible or tactile notification.

Modifying programming parameters permits restoration of IMD 12 toprevious settings or limitation of programming parameters to applicablesafety margins, and may involve causing the IMD to revert to a defaultset of programming parameters in the event the programming sessionfails. Delivery of therapy, either from the IMD or an external devicesuch as an automated external defibrillator, external drug pump, or thelike, maintains the patient's condition until medical help can beobtained.

An example scenario may involve a first parameter setting, which may bereprogrammed to a second parameter setting. For example, the firstparameter setting may provide for DDD pacing, and the second parametersetting may provide AAI, which leads to no ventricular pacing. If aprogramming session fails, the parameters in IMD 12 may be restored toprovide for DDD pacing. In another embodiment, “safe mode” parametersmay be set if they were passed to IMD 12 during initialization of theprogramming session. For example, IMD 12 may limit the programming,allowing only modes that support ventricular pacing.

FIG. 2 is a block diagram illustrating an exemplary implantable medicaldevice system 20 that implements fail-safe operations. FIG. 2illustrates details of a particular implementation of IMD system 10shown in FIG. 1. Accordingly, IMD system 20 may include the componentsof IMD system 10 as well as other devices that contribute to one or morefail-safe operations incident to a remote programming session. As shownin FIG. 2, IMD system 20 includes IMD 12, local programmer/monitor 14,network 16 and remote programmer 18. Local programmer/monitor 14 eitherincludes or interacts with a notification device 22 that generates anotification in response to an adverse event incident to a remoteprogramming session.

Notifying a person concerning the failure of the programming sessionincludes notifying a clinician or the patient by generating a visible,audible or tactile notification, sending an electronic message, sendinga postal mail letter, or the like. A notification device 22 provides thefunctionality for notifying a person concerning the failure of theprogramming session. In one embodiment, notification device 22 islocated within local programmer/monitor 14. In particular, an audiblealarm 26 or a visual alarm 28 may be located within or coupled tonotification device 22, thereby providing a notification to the patient.

In another embodiment, notification device 22 is located within IMD 12and is responsive to a programming session failure to provide an audiblenotification in the form of an alarm via a speaker provided in the IMD,or a tactile notification in the form of a vibration via a vibratingelement provided in the IMD. Other notifications, such as fragrances,stimulation shocks, or the like may be emitted by a notification devicewithin local programmer/monitor 14 or IMD 12 to alert the patient to thefailure of a programming session.

In other embodiments, notification device 22 sends an electronic messageas a notification, either to a patient or health care personnel, orboth. The electronic message includes one of a short messaging service(SMS) message, an instant messenger message, an email, an audible alerton a remote programmer, a visual alert on a remote programmer, anaudible alert on a wireless device, a visual alert on a wireless device,and the like.

Notification device 22 sends the notification via network 16, wirelessnetwork 32, or via Public Switched Telephone Network (PSTN) 34. Anantenna 30 enables a notification device 22 to communicate with wirelessnetwork 32. A connection with wireless network 32 allows communicationwith remote programmer 18 via PSTN 34 or network 16. In one embodiment,notification device 22 communicates directly via network 16.

In some embodiments, remote programmer 18 provides a notification tohealth care personnel, such as clinician, co-located with the remoteprogrammer. For example, remote programmer 18 may integrate or becoupled to a notification device that notifies the health care personnelof a programming failure in the event network communications fail.Remote programmer 18 detects communication failure, for example, inresponse to a timeout following a previous communication with receivingan acknowledgement or other reply from network equipment between theremote programmer and local programmer/monitor 14.

In each case, notification device 22 sends a notification to remoteprogrammer 10. In particular, PSTN 34 relays information about anadverse event or a parameter setting of IMD 12, enabling a clinician orother health care personnel to take appropriate action. In addition, asmentioned above, notification device 22 may send an electronic messageto a device associated with the patient, such as a handheld computingdevice, handheld programmer device, cellular telephone, or pager.

In addition to sending a notification, another fail-safe operationinvolves modifying programming parameters within the IMD 12. Forexample, upon detection of an adverse event such as a programmingsession failure due to a telecommunication link failure, localprogrammer/monitor 14 instructs IMD 12 to revert to a set of defaultparameters, rather than operate according to any parameters that mayhave been loaded as a result of the programming session.

As an alternative, IMD 12 may automatically revert to a set of defaultparameters in the event the local telemetry link fails or localprogrammer/monitor 14 indicates that the telecommunication link hasfailed. Detection of programming session failure may be based ondetection of an interruption of communication, failure to receive an endof programming verification such as a commit command or signal, receiptof a specific error signal, or other events.

The default parameters ensure at least basic operation of IMD 12 topreserve patient health, while avoiding potentially hazardous devicesettings that may result from incomplete programming or corruption ofinstructions or data. A memory module within IMD 12 or localprogrammer/monitor 14 stores previous parameter settings, such asdefault parameters for use in a fail-safe mode. In the event IMD 12 isconfigured to detect a failure of the programming session, the defaultparameters preferably are stored within a memory module in IMD 12.

As a further alternative, local programmer/monitor 14 may be configuredto transmit modified programming parameters to IMD 12 in the event anadverse event such as a programming session failure is detected. Insteadof causing IMD 12 to revert to a set of default parameters, localprogrammer/monitor 14 modifies some of the program parameters so thatthey reside within a conservative safety range established for theparticular IMD 12 and patient.

Local programmer/monitor 14 also may be configured to delivery a therapyin response to an adverse event associated with remote programming.Delivering therapy to a patient, another fail-safe operation, mayinclude therapy delivered via one of an automated external defibrillator(AED) 24, an external drug pump, an external neurostimulator, IMD 12, orother devices. For example, AED 24 may be integrated with remoteprogrammer 18 to monitor patient data, such as an electrocardiogram(ECG), and provide therapy if IMD 12 is not already providingappropriate therapy. In particular, AED 24 provides a fail-safe modeunder control of local programmer/monitor 14, e.g., if the patientexperience fibrillation due to improper operation of IMD 12 or during aperiod in which IMD 12 is unable to respond to the fibrillation due toimproper programming.

Another example of delivering therapy includes a drug pump that isdirected to release a prescribed amount of a medication in accordancewith a detected adverse event, e.g., under control of localprogrammer/monitor 18. Similarly, local programmer/monitor 18 maycontrol other types of devices such as neurostimulator to delivertherapy in the event IMD 12 operates improperly. Alternatively, in someembodiments, local programmer/monitor 18 presents visible or audibleinstructions to the patient to indicate a suggested therapy forself-administration by the patient.

In some embodiments, IMD 12 is configured to deliver therapy if anadverse event is detected as a result of a remote programming session.For example, IMD 12 may deliver particular pacing therapies in responseto detection of an adverse event. IMD 12 may deliver the therapies inresponse to notification of an adverse event by notification device 22or local programmer/monitor 14. The particular therapy available to thepatient can be specific to IMD 12, the patient, the clinician, thelocation of the patient or clinician, or other criteria.

In a further embodiment, a failure log is maintained within localprogrammer/monitor 14, remote programmer 18, or IMD 12. The failure logprovides information about the occurrence of adverse events in thecourse of a remote programming session. In this manner, the failure logaids the clinician in identifying improper programming states of IMD 12,as well as trouble-shooting potential sources of programming sessionfailures, such as components or software implicated in communication viaa telecommunication or telemetry link.

FIG. 3 is a conceptual diagram illustrating an exemplary implantablemedical device (IMD) 12 that provide fail-safe operations in response toan adverse event associated with remote programming. As shown in FIG. 3,IMD 12 includes a processor 36 that executes a failure detection module38 to detect adverse events relating to remote programming. IMD 12further includes a diagnostic interface 40 to sense physiologicalparameters within the patient, and a therapy interface 42 to delivertherapy such as electrical stimulation or drug administration. IMD 12also includes a telemetry interface for communication with localprogrammer/monitor 14 or a programmer in a clinician's office. In someembodiments, IMD 12 includes an internal notification device 22 tonotify the patient of an adverse event, e.g., by audible or tactilenotification.

IMD 12 includes components that aid in detection of adverse events anddefense against adverse events. Processor 36 detects either programmingsession failure or notifications of programming session failures, andinvokes fail-safe operations by other components of the IMD. Forexample, failure detection module 38, executed within processor 36, maydetect an adverse event, such as a programming session failure betweentelemetry interface 44 and a programmer. Processor 36 then directs anappropriate fail-safe operation in response to an adverse event.

A memory 46 stores new program parameters 48, default program parameters50, a control register 52 and a failure log 53. Accordingly, memory 46separates new program parameters received in the course of a remoteprogramming session from default program parameters, which arepersistently stored in the event of usage following detection of anadverse event. In particular, processor 36 loads control register 52with new program parameters 48 if the remote programming session issuccessful, but loads control register 52 with the default programparameters 50 if failure of the remote programming session is detected.IMD 12 then operates according to the parameters loaded in controlregister 52. Failure log 53 logs information concerning detection ofadverse events associated with remote programming sessions. Theinformation logged by failure log 53 may be sent to a device such asremote programmer 18.

In another embodiment, a first parameter setting is reprogrammed for aspecific period of time to a second parameter setting, after which thefirst setting may be restored automatically. This “test mode” embodimentmay be useful in testing situations, in which it is not desired to havethe second parameter setting be permanent. In an alternative embodiment,a series of parameter changes are programmed to be set in a sequence atpredetermined intervals. If IMD 12 detects a programming failure at anypoint in a series of parameter changes, IMD 12 can restore the firstparameter setting or maintain the second parameter setting if the secondparameter setting is still appropriate for the condition of the patient.The “test mode” parameters may be stored in new program parametersregister 48 or default program parameters register 50, and be passed tocontrol register 52 as directed by processor 36.

In a further embodiment, parameters may be queued in new programparameters register 48 while activation of a programmed parameter isdelayed intentionally. After the delay has been accomplished, thecondition of the patient may be monitored to verify that the programmedparameter is appropriate. The new programmed parameter setting may beaborted in favor of a default parameter setting if the changes are notappropriate for the condition of the patient.

Alternatively or, in addition, processor 36 notifies the patientconcerning the failure of the programming session via notificationdevice 22. Notification device 22 may emit include a vibration, a sound,or an electrical stimulation. Alternatively, notification device maysend a message to an external device via telemetry interface 44 to causethe device to emit a visible or audible notification, a voice prompt, afragrance, an electronic message, and the like. Again, the electronicmessage may include one of a short messaging service (SMS) message, aninstant messenger message, an email, an audible alert on a remoteprogrammer, a visual alert on a remote programmer, an audible alert on awireless device, a visual alert on a wireless device, and the like.

Delivering therapy to the patient, another fail-safe operation, includestherapy delivered via one of an automated external defibrillator (AED),a drug pump, an implantable monitor, a neurostimulator, IMD 12, and thelike. For example, IMD 12 may deliver appropriate therapy via therapyinterface 42 upon detection of an adverse event from failure detectionmodule 38. A diagnostic interface 40 may sense physiological conditionsfrom a patient and/or IMD 12 for diagnosing therapy. Diagnosticinterface 40 sends the physiological conditions to processor 36, whichdetermines an appropriate therapy according to the conditions. In thiscase, IMD 12 overrides new program parameters 48 if an adverse event,such as an inappropriate device operation or patient response, isdetected.

In another embodiment, therapy interface 42 is coupled to an externaldevice, which delivers therapy to a patient. For example, an AED may beintegrated with or coupled to local programmer/monitor 14 to monitorpatient data, such as an electrocardiogram (ECG), and provide therapy ifIMD 12 is not already providing appropriate therapy. Another example ofdelivering therapy may include a drug pump that is directed to release aprescribed amount of a medication in accordance with a detected adverseevent. Alternatively, instructions may be given to indicate thesuggested therapy that the patient should undergo. In each case,processor 36 controls telemetry interface 44 for communication with theexternal therapy device, either directly or indirectly via localprogrammer/monitor 14, to request delivery of therapy.

FIG. 4 is a conceptual diagram illustrating an exemplary localprogrammer/monitor 14 that provides fail-safe operations if an adverseevent associated with remote programming occurs. As shown in FIG. 4,local programmer/monitor 14 includes a processor 54 that executes afailure detection module 56 to detect an adverse event, such as aprogramming session failure between telemetry interface 59 and IMD 12,or between a telecommunication interface 61 and remote programmer 18. Inresponse to detection of an adverse event, processor 54 invokes anappropriate fail-safe operation, such as notifying a person concerningthe failure of the programming session via a notification device 22,modifying programming parameters within the implantable medical device,and delivering a therapy to a patient. Any combination of thesefail-safe operations may be used.

As further shown in FIG. 4, local programmer/monitor 14 may include atherapy interface 63 to control delivery of therapy from an externaltherapy device such as an AED, neurostimulator or drum pump. Also, insome embodiments, a failure log 65 may be updated if a programmingsession fails. Failure log 65 may provide information about theweaknesses of programming session connections. Failure log 65 mayinclude other information, such as information describing therapy thathas been delivered. In one embodiment, the information logged by failurelog 53 may be sent to a device such as remote programmer 18.

In some embodiments, a memory 60 buffers new program parameters 62received in the course of a remote programming session and defaultprogram parameters 64. In the event an adverse event is detected,processor 54 extracts default program parameters 64 from memory 60 andtransmits them to IMD 12. Alternatively, if the remote programmingsession is successful, processor 54 transmits the new program parameters62 to IMD 12 to program the IMD.

Thus, in the example of FIG. 4, new program parameters can be bufferedand accumulated, and then transmitted only if the remote programmingsession with remote programmer 18 was successful. Even after the newprogram parameters 62 are transmitted to IMD 12, processor 54 of localprogrammer/monitor 14 may send default program parameters 64 ifinappropriate operation or patient response is detected from IMD 12,e.g., in a case where IMD 12 notifies local programmer/monitor 14 ofinappropriate operation or patient response. Hence, FIG. 4 represents analternative to storage of default parameters within IMD 12, as in theexample of FIG. 3.

FIG. 5 is a flow diagram illustrating remote programming of animplantable medical device (IMD) 12 with exemplary fail-safefunctionality. As shown in FIG. 5, a remote programming session isinitiated to send programming parameters (70), e.g., by a remoteprogrammer 18. Remote programmer 18 communicates with localprogrammer/monitor 14 via network 16 to conduct the remote programmingsession. In the course of the remote programming session, remoteprogrammer 18 sends parameters to IMD 22 via local programmer/monitor14. IMD 12, remote programmer 18, or local programmer/monitor 14 detectswhether the programming session fails (72).

The programming session may fail for a number of reasons. For example,there may be a disruption in telemetry between IMD 12 and localprogrammer 14 located proximate IMD 12. Alternatively, there may be adisruption in a telecommunication link between the local programmer 14and remote programmer 18. It is also possible that the programmingsession may fail due to a loss of connection between clinicianinstrumentation and remote programmer 18, or due to a loss of a networkconnection. The programming session may also fail if any initializationinstructions or programming parameters were corrupted.

In the event the programming session fails (72), a fail-safe operationis invoked (74), e.g., by IMD 12, local programmer/monitor 14, or remoteprogrammer 18, as described herein. In one embodiment, a failure log maybe updated (76) after a programming session fails. The failure log mayprovide information about the weaknesses of programming sessionconnections. In addition, the failure log may include other information,such as information describing therapy that has been delivered.

In one embodiment, the information logged by failure log 53 may be sentto a device such as remote programmer 18. If the programming sessiondoes not fail and the programming session is not complete (80), then theprogramming session will continue (78) until it fails or ends. If theprogramming session does not fail and the programming session is notcomplete (80), then program parameters from the programming may beloaded into IMD 12 (82).

FIG. 6 is a flow diagram illustrating remote programming of animplantable medical device (IMD) with exemplary fail-safe functionality.As shown in FIG. 6, a remote programming session is initiated to sendprogramming parameters (84). IMD 12 or local programmer/monitor 14 thendetects whether an adverse event has occurred (86). Again, an adverseevent may include one of a programming session failure, inappropriatedevice behavior, and inappropriate patient response.

Inappropriate device behavior may comprise one of an asystole by IMD 12,inappropriate IMD sensitivity settings, inappropriate AV delay settings,inappropriate pacing and defibrillation output settings, inappropriaterefractory period settings, and the like. Inappropriate patient responsemay include low pacing outputs, low pacing rate, loss of capture, lossof sensing or monitoring, loss of defibrillation efficacy, arrhythmia,and the like.

In the event an adverse event is detected (86), it may be determinedthat the programming parameter setting for IMD 12 is inappropriate (88).However, the occurrence of adverse event may not necessarily mean asetting is programming parameter inappropriate. If an adverse event isdetected but the programming parameter setting is still appropriate,then the setting will not be changed. If an adverse event is detected,the programming parameter setting is determined to be inappropriate, theprogramming parameter setting has been programmed (89) then IMD 12 maydirect one or more parameters to revert to a default parameter setting(90).

For example, IMD 12 may load the default parameters into controlregister 52 (FIG. 3). Alternatively, IMD 12 may set a parameter to asetting of a “safe mode” setting within a safety range determined forthe IMD and the patient. If the setting had not yet been programmed, itmay not be necessary to revert to a default setting or enter into a“safe mode”. In one embodiment, a failure log may be updated (92) afteran adverse event is detected. The failure log may provide informationabout the weaknesses of programming session connections. As indicatedabove, the failure log may include other information, such asinformation describing therapy that has been delivered. In oneembodiment, the information logged by failure log 53 may be sent to adevice such as remote programmer 18.

If the adverse event is not detected and the programming session is notcomplete (96), then the programming session will continue (94) until itends or an adverse event is detected. If the adverse event is notdetected and the programming session is complete (96), then programparameters from the programming may be loaded into IMD 12 (98). Afterrunning with the program parameters, IMD 12 may be monitored again todetect an adverse event.

Various embodiments of the invention have been described. These andother embodiments are within the scope of the following claims.

1. A method comprising: initiating a remote programming session withinan implantable medical device over a long-range telecommunication link,the remote programming session comprising providing signals from aprogramming device separate and remote from the implantable medicaldevice to program the implantable medical device with operatingparameters defining operation of the implantable medical device, theremote programming device being at a site located a significant distancefrom the implantable medical device; in the event the remote programmingsession succeeds, operating the implantable medical device according tothe operating parameters following the remote programming session; andinvoking a fail-safe operation in the event the remote programmingsession fails, wherein invoking the fail-safe operation includesautomatically modifying the operating parameters of the implantablemedical device and operating the implantable medical device according tothe modified operating parameters following the failed remoteprogramming session.
 2. The method of claim 1, wherein invoking thefail-safe operation includes notifying a person concerning the failureof the programming session.
 3. The method of claim 2, wherein notifyinga person includes generating an alarm from within the implantablemedical device.
 4. The method of claim 3, wherein generating an alarmfrom within the implantable medical device comprises generating one of avibration and a sound.
 5. The method of claim 2, wherein notifying aperson comprises sending an electronic message to the person.
 6. Themethod of claim 5, wherein the electronic message includes one of ashort messaging service (SMS) message, an instant messenger message, anemail, an audible alert on a remote programmer, a visual alert on aremote programmer, an audible alert on a wireless device, and a visualalert on a wireless device.
 7. The method of claim 1, wherein modifyingthe operating parameters includes waiting for a delay period followingthe failed programming session before modifying the operatingparameters.
 8. The method of claim 1, wherein operating the implantablemedical device according to the modified operating parameters comprisesdelivering a therapy to a patient based on the modified operatingparameters via one of an automated external defibrillator (AED), a drugpump, a neurostimulator, and the implantable medical device.
 9. Themethod of claim 1, wherein the implantable medical device includes oneof a cardiac pacemaker, a neurostimulator, and a drug pump.
 10. Themethod of claim 1, wherein providing signals from a programming deviceseparate and remote from the implantable medical device to program theimplantable medical device comprises: transmitting first signals fromthe remote programming device to a local programmer; and transmittingsecond signals from the local programmer to the implantable medicaldevice.
 11. The method of claim 10, wherein the first signals aretransmitted via the Internet.
 12. The method of claim 1, whereinmodifying the operating parameters comprises reverting to defaultoperating parameters.
 13. The method of claim 1, wherein modifying theoperating parameters comprises restoring a previous operating parametersetting.
 14. The method of claim 1, wherein operating the implantablemedical device according to the first operating parameters comprisesdelivering therapy to the patient according to the first operatingparameters.
 15. The method of claim 1, wherein operating the implantablemedical device according to the first operating parameters comprisesmonitoring one or more patient parameters according to the firstoperating parameters.